Spina Bifida & Neural Tube Defects

The most common form is Myelomeningocele, where a sac of fluid containing spinal nerves protrudes through an opening in the back. Because the nerves are exposed to the amniotic fluid, they become damaged over time.

Spina Bifida also affects the brain through a mechanism called the Chiari II Malformation. Because of the opening in the spine, the fluid around the brain 'leaks' down, causing the base of the brain (the cerebellum) to be pulled downwards. This creates the classic 'Banana Sign' and 'Lemon Sign' (the shape of the baby's head) that we see on ultrasound.

The primary risk factor for NTDs is a deficiency in Folic Acid (Vitamin B9) during the very first weeks of pregnancy, often before a woman knows she is pregnant.

• Other risks include certain maternal medications (like anti-seizure drugs) or pre-existing maternal diabetes.
• If you have had one pregnancy affected by Spina Bifida, your risk for future pregnancies increases, and we recommend a much higher dose of Folic Acid (5mg) starting 3 months before conception.

Most cases are diagnosed during the 20-week anomaly scan, though subtle brain signs can often be seen as early as 12-13 weeks.

1. Brain Markers: The 'Lemon Sign' (flattening of the forehead) and the 'Banana Sign' (curved cerebellum) are highly accurate screening markers.
2. Spinal Level: We meticulously scan every vertebra to determine the 'level' of the defect (e.g., L3 or S1). The lower the defect is on the spine, the better the prognosis for walking.
3. Limb Movement: We observe the baby's leg and foot movements (checking for 'clubfoot' or reduced motion).

After diagnosis, the team maps the lesion, assesses the brain and other anatomy, offers genetic evaluation where appropriate, and discusses likely mobility, bladder and bowel function, hydrocephalus, delivery, and neonatal care. Options may include postnatal repair or referral to a specialist fetal-surgery centre for prenatal-repair assessment. Any prenatal intervention requires strict multidisciplinary selection, institutional approval, detailed consent, appropriate research or innovation governance, prospective registration, and outcome audit.

Children with Spina Bifida can lead long, fulfilling lives.

• Mobility: Many children learn to walk, though some may require braces or a wheelchair if the defect is high on the spine.
• Brain Health: Prenatal surgery significantly reduces the risk of needing a 'shunt' for hydrocephalus.
• Cognition: Most children with Spina Bifida have normal intelligence, though they may face specific learning challenges related to spatial reasoning.
• Multidisciplinary Care: These children require a life-long team including urologists, orthopedists, and neurosurgeons.

Suspected spina bifida should be referred promptly to Maternal-Fetal Medicine for confirmation, full anatomical assessment, genetic counselling, and multidisciplinary planning. Where prenatal repair might be relevant, we coordinate assessment with an appropriately governed specialist programme; Fetus.ae does not present prenatal repair as a routine service of our unit.